Regurgitation and Gastroesophageal Reflux in Infants

Regurgitation, also known as spitting up, is quite common in infants. It is usually caused by immature muscles in the digestive tract. Unlike gastroesophageal reflux (GER), which can be or become a health problem, spitting up is not painful and does not have any repercussions on the child's health.

How do they differ?

When infants regurgitate, they usually spit up a small amount of milk. Though it may seem abundant, it only appears this way because the regurgitated contents usually contain gastric juices and saliva as well. In spite of spitting up, babies remain happy and continue to gain weight. Regurgitation in infants is very common and often occurs after a feeding. Unlike simple regurgitation, infants with GER experience discomfort when spitting up and may lose weight or be very slow to gain weight. The problem is therefore considered more serious. On occasion, infants may refuse to feed or are fussy during feedings. GER can appear several hours after a feeding.

Causes

In infants, the esophageal sphincter is not completely formed. Located between the stomach and the esophagus (the tube that connects the mouth to the stomach), that valve-like sphincter prevents food from flowing back up towards the mouth. Furthermore, the mechanism involved in transferring the stomach contents to the intestines is not fully developed either. Both regurgitations and GER gradually disappear during the child's first year as the digestive tract matures and the child begins to stand upright more consistently.

Persons most at risk

Premature babies, children who have had surgery for esophageal disorders, who suffer from pulmonary problems (asthma, cystic fibrosis), who lack muscle tone and have other developmental problems (Down syndrome, for example) are most at risk for regurgitation and GER.

Diagnosis

If the symptoms present are not related only to regurgitation, the physician will conduct a medical examination and, if necessary, will request additional tests. If the physician prescribes additional testing for your child, do not hesitate to speak to the nurse or the physician to find out if there are precautions you should follow before the test.

Complications

Unlike GER, simple regurgitation does not have any serious consequences on the child's overall health. If left untreated, GER may lead to other complications including:

• Aspiration of stomach contents into the lungs which may lead to more frequent respiratory problems (bronchitis, laryngitis, otitis, persistent cough, etc.);
• Poor growth;
• Esophagitis (irritation of the esophagus).

Treatment and Prevention

A few simple measures can be taken to reduce spitting up:

• Burp the baby several times during each feeding while holding the child upright against yourself. Do not pat the child's back;
• Keep your child in an upright position for a while after each feeding - in other words, wait before lying the child down and avoid vigorous play;
• Avoid sitting the child in its car seat after a feeding. Sitting puts pressure on the stomach and can aggravate the problem;
• When putting the child down to sleep, do not incline unless recommended by your physician.
• Use a slow flow nipple when bottle feeding;
• Avoid tight clothes and diapers;
• Speak to your healthcare professional before changing or thickening your child's formula, and if you are breastfeeding, before excluding food from your diet;
• Provide your child with a smoke-free environment;
• Offer smaller feedings more frequently;
• Never lie a child on its side or stomach unless directed by your physician as it increases the risk for sudden infant death syndrome.

In addition to the aforementioned measures, medications that are safe for children can be used to effectively treat GER. In exceptionally rare situations, surgery may be required.

When to consult?

Infants with regurgitation or reflux who also have the following signs or symptoms should be evaluated by a physician:

• Recurrent vomiting;
• Blood in regurgitation;
• Severe diarrhea, bloody stools;
• pneumonia;
• Poor growth;
• Refusing to eat or drink anything for a prolonged period;
• infant under three months of age who has forceful vomiting after each feed;
• Behavior changes (lethargic or decreased responsiveness).

If you have any questions, speak to your pharmacist.